Auricular injury as a presentation of child abuse.

Child abuse causes serious physical and emotional injury. Those abused, however, are usually unable or unwilling to gain access to agencies that might help them. The otolaryngologist, while usually not the patient's primary physician, may be in the position to detect child abuse. We describe a 3-year-old boy who sustained auricular trauma as the result of child abuse. The importance of physician recognition of an abuse case and the institution of appropriate measures are discussed.     

Comprehensive evaluation of a child with an auditory brainstem implant.

OBJECTIVE: We had an opportunity to evaluate an American child whose family traveled to Italy to receive an auditory brainstem implant (ABI). The goal of this evaluation was to obtain insight into possible benefits derived from the ABI and to begin developing assessment protocols for pediatric clinical trials. STUDY DESIGN: Case study. SETTING: Tertiary referral center. PATIENT: Pediatric ABI Patient 1 was born with auditory nerve agenesis. Auditory brainstem implant surgery was performed in December, 2005, in Verona, Italy. The child was assessed at the House Ear Institute, Los Angeles, in July 2006 at the age of 3 years 11 months. Follow-up assessment has continued at the HEAR Center in Birmingham, Alabama. INTERVENTION: Auditory brainstem implant. MAIN OUTCOME MEASURES: Performance was assessed for the domains of audition, speech and language, intelligence and behavior, quality of life, and parental factors. RESULTS: Patient 1 demonstrated detection of sound, speech pattern perception with visual cues, and inconsistent auditory-only vowel discrimination. Language age with signs was approximately 2 years, and vocalizations were increasing. Of normal intelligence, he exhibited attention deficits with difficulty completing structured tasks. Twelve months later, this child was able to identify speech patterns consistently; closed-set word identification was emerging. These results were within the range of performance for a small sample of similarly aged pediatric cochlear implant users. CONCLUSION: Pediatric ABI assessment with a group of well-selected children is needed to examine risk versus benefit in this population and to analyze whether open-set speech recognition is achievable.     

Psychological evaluation of the child with a suspected central auditory dysfunction

I have attempted to summarize the role of the psychologist and psychological evaluation in assessing a child with a suspected central auditory dysfunction. The reasons why a child may be referred for a psychological evaluation along with some of the exhibiting behaviors were discussed. The role of the psychological evaluation was examined. The indications for psychological evaluation in central auditory dysfunction were presented and alternative types of education were discussed.     

Otoneurologic evaluation of child vertigo

In this study 282 children with vertigo are subdivided (according to previous experiences) into three large groups: (1) vertigo and cochlear diseases; (2) vertigo as an isolated symptom; and (3) vertigo and C.S.N. diseases. Due to the difficult etiopathogenetic investigation of the patients from the second group, the authors focused on that group as they are less studied, are without associated symptoms (deafness—first group; CNS diseases—second group) and where vertigo appears as an idiopathic and an isolated symptom. A careful anamnestic, clinical and instrumental analysis leads to the following observations; (1) in decreasing order of frequency we find the third group, followed by the first and finally by the second; (2) in spite of the overall lower incidence of the second group, this latter includes the paroxismal benign vertigo (PBV) which is overall the second most frequent vertiginous form (after vertigo due to cranial trauma). In this group the authors underline the reasonably high incidence of the iatrogenic syndromes, insisting on the need of their accurate prevention of these risks; (3) the authors confirm that, nowadays, a reliable etiopathogenetic cause of the apparently isolated vertigo (except for the ascertained iatrogenic forms) cannot be identified. Moreover, in spite of its frequency, PBV is the less known form of vertigo, of which we cannot give a certain diagnosis and which can be identified only by the exclusion of all the other known forms through instrumental and clinical observations.     

Complete avulsion of the scalp. Apropos of a case

The authors present a case about a traumatic totally avulsed scalp, realizing a loss of substance of 1,000 cm2. After the unsuccessful treatment with classical methods by skin grafting, a mixed myocutaneous Latissimus Dorsi and cutaneous parascapular flap allow the coverage of 25 centimetres of the scalp in his larger axis. The remaining surface is covered with full-thickness skin grafts. Though unperfect according to the esthetic aspect, the result is stable 6 months after the operation.     

Evidence-based algorithm for the evaluation of a child with bilateral sensorineural hearing loss

OBJECTIVE: To develop an evidence-based algorithm for determining the etiology of bilateral sensorineural hearing loss (SNHL) in a child. METHODS: The frequency of different etiologies was previously determined. A systematic review of the literature for articles published between 1940 and January 2003 was performed for studies providing information on the diagnosis of each etiology relevant to their clinical presentation. RESULTS: Connexin mutation testing is highly sensitive and specific. CT scanning of the temporal bones is frequently valuable in detecting inner ear malformations. Routine laboratory studies are rarely helpful. ECG is particularly valuable when a history of syncope or arrhythmias or a family history of sudden death in a young child is elicited. There is no literature to support routine urinalysis for the diagnosis of Alport syndrome and thyroid studies lack specificity in the absence of physical findings (goiter). CONCLUSIONS: An evidence-based algorithm was developed that included: history, physical and audiological evaluation, and ophthalmological evaluation. Further directed investigations may include genetic testing for the Cx26 mutation, CT scan of the temporal bones, ECG and urinalysis.     

Complete mandibular agenesis. Report of a case

A child had complete mandibular agenesis, with associated anomalies of microstomia, left choanal stenosis, and a cleft soft palate. This child had evidence of disruption in development at about the four-week stage by the persistence of several developmental remnants, specifically, the buccopharyngeal membrane, tongue remnants, and the laryngotracheal groove. The etiology of this condition is unclear at this time.     

Acceptability ratings and intelligibility scores of alaryngeal speakers by three listener groups.

Acceptability and intelligibility of three groups of alaryngeal speakers were examined: four oesophageal speakers, four tracheo-oesophageal puncture speakers using a tracheostoma valve and four tracheo-oesophageal puncture speakers using digital occlusion. Speakers were video-taped producing samples from the Assessment of Intelligibility of Dysarthric Speech, in addition to a section of spontaneous speech. Three groups of listeners were used: nine speech and language therapists, five ENT surgeons and ten na?ve listeners. Specific variables including fluency, rate, quality, intensity, extraneous noise, effort required, pitch and general acceptability were rated on a 7-point scale. Overall no significant difference was found between the speaker groups but listener groups did obtain significantly different intelligibility scores with speech and language therapists scoring highest and ENT surgeons lowest. Analysis suggests that speech and language therapist listeners cope equally well with all speaker groups but ENT surgeons and na?ve listeners cope best with tracheo-oesophageal puncture speakers using the tracheostoma valve; only the data from ENT surgeons showed a significant difference between scores for the different speaker groups.     

Zygomycosis presenting as nasal polyps in a healthy child

A 15-year-old boy presented with unilateral nasal polyps. Pathological examination showed submucosal granulomas and fungal organisms with occasionally septate hyphae. These organisms were identified by the Centers for Disease Control, Atlanta, as being members of the class of fungi known as Zygomycetes (formerly Phycomycetes). Based on strong morphological and clinical criteria, we believe the causative organism to be Entomophthora coronata. The patient had no evidence of diabetes mellitus or compromised immunity. This patient represents an unusual case of nasal polyps caused by an organism that has rarely been diagnosed in North America.     

Granular cell tumor of the trachea in a child.

Granular cell tumors are benign neoplasms found most commonly in the head and neck, particularly the tongue. They have, however, been described in all areas of the body. Their presentation in the trachea is exceedingly rare, with their presence in the pediatric trachea being an even rarer occurrence. We describe a case of a granular cell tumor of the trachea in a 10-year-old boy with a dramatic, almost lethal, presentation. This is followed by a review of the literature, including pathology and treatment options.     

Complete pathologic response as a prognostic factor for squamous cell carcinoma of the oropharynx post-chemoradiotherapy

IntroductionChemoradiotherapy for squamous cell carcinoma of the oropharynx (SCCO) provides good results for locoregional disease control, with high rates of complete clinical and pathologic responses, mainly in the neck.ObjectiveTo determine whether complete pathologic response after chemoradiotherapy is related to the prognosis of patients with SCCO.MethodsData were prospectively extracted from clinical records of N2 and N3 SCCO patients submitted to a planned neck dissection after chemoradiotherapy.ResultsA total of 19 patients were evaluated. Half of patients obtained complete pathologic response in the neck. Distant or locoregional recurrence occurred in approximately 42% of patients, and 26% died. Statistical analysis showed an association between complete pathologic response and lower disease recurrence rate (77.8% vs. 20.8%; p = 0.017) and greater overall survival (88.9% vs. 23.3%; p = 0.049).ConclusionThe presence of a complete pathologic response after chemoradiotherapy positively influences the prognosis of patients with SCCO.     

Measurement of the temporal-modulation transfer function for a single listener with cochlear hearing loss and left-hemisphere damage

The modulation depth required for the detection of sinusoidal amplitude-modulation applied to a white noise carrier was measured as a function of modulation frequency, giving temporal modulation transfer functions (TMTFs). Five adult listeners with normal hearing (mean age 52 years), five elderly listeners with moderate cochlear hearing loss (mean age 66 years) and a single elderly listener (aged 73 years) with moderate cochlear hearing loss and left-hemisphere damage were tested in the right ear at 50 dB SL. The five elderly listeners were matched in audiogram with the brain-damaged listener. Modulation detection was systematically poorer than normal in the five elderly listeners with cochlear hearing loss. However, their TMTFs were lowpass in shape, as for the five normal-hearing adult listeners. Modulation detection was much poorer in the elderly listener with cochlear hearing loss and left-hemisphere damage compared to the five normal-hearing adults and the five elderly listeners with cochlear hearing loss. Moreover, modulation detection was poorer at 4, 64 and 128 Hz than at 8, 16 and 32 Hz in the brain-damaged listener, giving his TMTF a bandpass appearance. These results are in agreement with the hypothesis that the main factors limiting the ability to detect changes in the temporal-envelope of sounds are located at a central (retro-cochlear) level of the auditory system rather than at a peripheral (cochlear) level. They also suggest that the TMTF approach may prove useful in distinguishing peripheral and central hearing losses.     

Graft-vs-host disease as a cause of enlargement of the epiglottis in an immunocompromised child

We report a rare case of dyspnea due to enlargement of the epiglottis in a severely immunocompromised patient. The child underwent a previous tracheostomy at another hospital because of respiratory distress under the diagnosis of acute epiglottitis. The patient was subsequently decannulated without incident. One year later, the child developed a new episode of dyspnea with inspiratory stridor. A new tracheostomy was neccessary, and a biopsy specimen of the enlarged epiglottis was taken to confirm the diagnosis of graft-vs-host disease. The therapeutic measures in these situations are discussed below, and a review of the current literature concerning the etiology and management of epiglottic enlargement is performed.     

Counseling families with a hearing-impaired child.

Parents are the linchpin of the family, and counseling for the young, newly diagnosed child with a hearing impairment needs to be directed at them. The operative rule for the counseling model described in this article is that feelings are neither good nor bad; they just are, and they need acknowledgment and acceptance, never judgment. Behavior can be judged as to whether or not it is productive, but parents never have to be responsible for how they feel. Armed with this nonjudgmental attitude toward emotions, the clinician can elicit them by empathetic listening.